Bell's Palsy Care Staff Guide: Telling It Apart From a Stroke

A resident wakes up with one side of their face drooping. They cannot close an eye properly, their smile looks uneven and their speech is a little slurred. For staff, the first question is always the same: is this a stroke? Bell's palsy can look very similar, but a stroke is a medical emergency, and the two cannot be told apart by looking.

This guide explains what Bell's palsy is, how it differs from the signs of stroke, what the NHS says about treatment, and how care staff can support someone through recovery. It draws on the NHS guidance on Bell's palsy. The NHS page is due for review, so please check the latest NHS guidance alongside this article.

What is Bell's palsy?

Bell's palsy causes weakness or paralysis on one side of the face, usually developing over a few days. The NHS lists these symptoms:

• A drooping eyelid or mouth corner on one side.
• Drooling or a dry mouth.
• Loss of taste.
• A dry or watering eye.
• Difficulty closing the affected eye.

In rare cases both sides of the face are affected. The NHS page does not set out a cause, and care staff do not need to work one out. The task is to recognise the change, get the right help quickly and protect the person while they recover.

Bell's palsy or stroke? Why you must treat it as an emergency first

The NHS is clear that facial drooping on one side can be a sign of stroke. It tells people to call 999 if someone has any of these signs:

• Their face has drooped on one side and they cannot smile evenly.
• They cannot raise both arms and keep them there.
• Their speech is slurred or garbled.

Staff should not try to decide between Bell's palsy and stroke themselves. Use the FAST test, call 999 and say clearly that you suspect a stroke. Our guide to stroke recognition and the FAST test explains the steps in more detail. If paramedics or the hospital team decide it is Bell's palsy, little is lost; if it is a stroke, every minute matters.

If there are no stroke signs apart from facial weakness, the NHS advice for Bell's palsy is to contact a GP urgently or use NHS 111. In a care setting, follow your organisation's procedure and escalate the same day, because treatment works best when started early.

Why timing matters

The NHS says that treatment for Bell's palsy works best if it starts within 72 hours of symptoms beginning. This is one reason to note down exactly when you first noticed the change, and when the person was last seen with a normal face. Even if the cause turns out to be a stroke, that time is also the key piece of information emergency services need.

Treatment

According to the NHS, treatment for Bell's palsy includes:

• Steroid medicine, usually a 10-day course, sometimes with antiviral medicine. Starting early matters.
• Eye drops and ointment to stop the eye drying out.
• Surgical tape to keep the eye closed at bedtime.
• Treatment to prevent damage to vision, which may be needed if the eye cannot close.

Prescribing decisions belong to the GP or hospital team. Care staff's role is to make sure that medicines and eye care happen as prescribed, and that nobody with an eye that will not close is left without the eye care they have been advised to use.

Recovery and what to expect

The NHS says most people improve within six months, though some take longer. A GP should be seen if there is no improvement after three weeks. Permanent weakness is possible, and the NHS lists possible lasting problems including facial pain, constant eye watering, difficulty eating or drinking, changes in taste and sensitivity to loud sounds. It usually happens only once, although it can rarely recur years later.

Facial changes can also affect mood. The NHS notes that low mood, stress or anxiety can occur. For some people, particularly those who already live with anxiety or depression, how they look matters, so a kind and unhurried approach from staff is part of the treatment.

Practical support for care staff

The following points are general good practice; follow the person's care plan and any clinical advice.

• Eye care: make sure drops, ointment and any tape or eye protection are used as directed, and report redness, pain or changes in vision to the GP or nurse.
• Eating and drinking: facial weakness can make chewing and swallowing harder. Offer smaller mouthfuls, check for food collecting in the cheek and report any coughing or choking.
• Communication: allow extra time. Speech may sound different and expressions are harder to read, so check understanding rather than assuming it.
• Mouth care: dry mouth and food trapped in one side can affect dental hygiene.
• Emotional support: acknowledge that the change in appearance can be upsetting, and report persistent low mood.
• Recording: note the time symptoms started, what you observed, who you contacted and what advice was given.

Facial pain is a different problem. If someone describes sudden, severe, stabbing pain in the face, rather than weakness, our guide to trigeminal neuralgia covers a separate condition.

Training and CPD

Telling an emergency from a minor problem is a skill that improves with practice and discussion. Record what you learn in your CPD log, talk through real examples in supervision, and browse the options on our CPD pages.

Key points to remember

• Facial drooping on one side can be a stroke. Use FAST and call 999 if there are stroke signs.
• Bell's palsy causes one-sided facial weakness over a few days; treatment works best within 72 hours.
• Treatment usually includes a steroid course and careful eye protection.
• Most people improve within six months; see a GP if there is no improvement after three weeks.
• Note when symptoms started and support eating, communication and mood.

Frequently asked questions

Can care staff tell Bell's palsy from a stroke?

No. The two can look alike, and the NHS tells people to call 999 for facial drooping with other stroke signs. Staff should escalate rather than diagnose.

How long does Bell's palsy last?

The NHS says most people improve within six months, though some take longer and some have lasting weakness.

Why is the eye such a priority?

If the eye cannot close, it can dry out and become damaged. The NHS recommends eye drops, ointment and sometimes tape or protection to prevent harm to vision.

This guide is for general information and is not a substitute for clinical advice or your organisation's policies.